Cost-Effectiveness Analysis of Endovascular Coiling versus Neurosurgical Clipping for Intracranial Aneurysms in Republic of Korea

Abstract

PurposeThe International Subarachnoid Aneurysm Trial (ISAT) revealed that in ruptured intracranial aneurysms (RA), endovascular coiling (EC) yields better clinical outcomes than neurosurgical clipping (NC) at 1 year. In unruptured aneurysms (UIA), EC is being increasingly used as an alternative to NC due to patients' preference. There is a lot of difference in treatment cost (EC vs. NC) between countries. There is one recently published study dealing with the comparative cost analysis only in UIAs in South Korea. But it is a hospital-based study. So, the authors performed a nation-wide cost effective comparison in our country.Materials and MethodsThis study was a retrospective analysis of healthcare big data open systems in Health Insurance Review & Assessment Service (HIRA). Hospital cost data of the recent 5 years (from January 2010 to December 2014) were analyzed according to patients' age and sex and the presence of subarachnoid hemorrhage.ResultsWhen comparing the total hospital costs for NC of a UIA (n=13,756) and EC of a UIA (n=17,666), NC [mean±standard deviation (SD): ￦7,987,179±3,855,029] resulted in significantly lower total hospital costs than EC [￦10,201,645±5,001,626, p<0.0001], although a shorter hospital stay with EC of a UIA [8.6 ±7.4 days] vs. NC [15.0 ±8.3 days, p<0.0001]. When comparing the total hospital costs for NC of a RA (n=7,293) and EC of a RA (n=6,954), NC [￦13,914,993±6,247,914] resulted in significantly lower total hospital costs than EC [￦16,702,446±7,841,141, p<0.0001], although shorter hospital stays for EC of a RA [19.8 ±11.4] vs. NC [23.0 ±10.3, p<0.0001].ConclusionThe total hospital costs for the NC of both UIAs and RAs were found to be lower than those for EC in South Korea.

Monthly variations in aneurysmal subarachnoid hemorrhage incidence and mortality: Correlation with weather and pollution

“…[ 19 , 20 ] As each person has a unique resident registration number, duplication of patients can be avoided. [ 21 ] All patients with primary or secondary SAH diagnosis codes of I60 to I609, based on the International Classification of Diseases, tenth edition (ICD-10), were searched and extracted. Initially, we identified a total of 71,737 patients with spontaneous SAH.…”

A cost-utility analysis comparing endovascular coiling to neurosurgical clipping in the treatment of aneurysmal subarachnoid haemorrhage

“…A literature review was conducted using a combination of keywords ‘Endovascular Coiling’, ‘Neurosurgical Clipping’, ‘Aneurysmal Subarachnoid Haemorrhage’, ‘Cost Utility Analysis’ and ‘Economic Evaluation’ in 5 main databases—Embase, Medline, Google Scholar, Science Direct, PubMed. There were a few cost-effectiveness studies published by region or specific location, such as in developing countries [ 26 ] or the Republic of Korea [ 27 ], but no cost-utility analysis between both interventions has previously been performed. The search also yielded several systematic reviews and meta-analyses on the clinical outcomes and costs of both interventions.…”

Anterior communicating artery aneurysm rupture and functional outcome in short-term: clipping versus coiling

“…When considering the costs of hospitalization and intervention -i.e., devices -into account, it seems that coiling is still more expensive than in clipping, even though the patient's overall hospital stay is shorter (Chang et al, 2016;Duan et al, 2015).…”